Case Study: Healthcare Insurer Company achieves faster claims resolution and significant FTE reductions with UiPath

Healthcare Payer Challenges and Solutions

Healthcare Insurer Company faced persistent claims-processing bottlenecks: 1–2 thousand claims stopped daily for a simple error code (about 3–4% of volume), 500–1,500 daily claims held for minor front-end edits, and complex coordination-of-benefits (COB) adjudication that required agents to gather many documents. To address these gaps the payer engaged UiPath to deploy RPA robots and automation scripts that mirror the claims group’s business rules.

UiPath implemented robots to auto-correct error releases, route and perform minor edits from work queues, and assemble documentation for COB cases. The automation removed roughly 25 FTEs from the error-fix process and cut two- to three-day bottlenecks to same-day resolution; it replaced about 10–12 FTEs for minor edits and cut task time from 10–15 minutes to 1–2 minutes (scaling easily for volume spikes); and it returned about two hours per agent per day by assembling COB materials—delivering measurable efficiency and capacity gains.